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Introduction Coronavirus related lockdown measures had a severe psychological toll. We investigated the effects of population-wide infection control measures on hemodialysis (HD) and oncology patients' mood statuses. Methods An electronic survey was used to collect data. We used the Profile of Mood States (POMS) and the Hospital Anxiety and Depression Scale (HADS) to measure the mood statuses. Results The study groups composed of 400 HD, 234 oncology patients, and 276 controls. HADS anxiety and total POMS scores were significantly higher in the control group than that of both HD and oncology patients, a finding consistent with a worse mood status. In multivariate models, the male gender and the perception of having received appropriate medical support during the pandemic period were independent predictors of better POMS and HADS-anxiety and depression scores. Conclusion Hemodialysis and oncology patients appear to be less affected by the psychological stress induced by social distancing and lockdown periods. This article is protected by copyright. All rights reserved.

Objective To characterize system-level barriers to bariatric surgery from the perspectives of Veterans with severe obesity and obesity care providers. Summary of background data Bariatric surgery is the most effective weight loss option for Veterans with severe obesity, but fewer than 0.1% of Veterans with severe obesity undergo it. Addressing low utilization of bariatric surgery and weight management services is a priority for the veterans health administration. Methods We conducted semi-structured interviews with Veterans with severe obesity who were referred for or underwent bariatric surgery, and providers who delivered care to veterans with severe obesity, including bariatric surgeons, primary care providers, registered dietitians, and health psychologists. We asked study participants to describe their experiences with the bariatric surgery delivery process in the VA system. All interviews were audio-recorded and transcribed. Four coders iteratively developed a codebook and used conventional content analysis to identify relevant systems or "contextual" barriers within Andersen Behavioral Model of Health Services Use. Results Seventy-three semi-structured interviews with veterans (n = 33) and providers (n = 40) throughout the veterans health administration system were completed. More than three-fourths of Veterans were male, whereas nearly three-fourths of the providers were female. Eight themes were mapped onto Andersen model as barriers to bariatric surgery: poor care coordination, lack of bariatric surgery guidelines, limited primary care providers and referring provider knowledge about bariatric surgery, long travel distances, delayed referrals, limited access to healthy foods, difficulties meetings preoperative requirements, and lack of provider availability and/or time. Conclusions Addressing system-level barriers by improving coordination of care and standardizing some aspects of bariatric surgery care may improve access to evidence-based severe obesity care within VA.

We aimed to investigate the value of follicular fluid fetuins-A and -B to predict successful IVF and pregnancy outcomes in infertile women with poor, normal, and high ovarian reserve.The follicular fluid of 96 infertile women who underwent intra-cytoplasmic sperm injection (ICSI) procedure was analyzed. Fetuins-A and -B levels were examined and compared in those who could achieve pregnancy and those who could not. Receiver operating characteristic curve analyzes were used to determine cut-off and statistically significant associations for fetuins-A and -B.Follicular fluid fetuin-A levels were higher in cases with weak ovarian reserve (OR) (p 0.05) and higher in patients who did not achieve clinical pregnancy (p 0.05). Conversely, the follicular fluid fetuin-B levels were lower in cases with poor OR (p 0.05) and were lower in patients who did not achieve a clinical pregnancy (p 0.05). A follicular fluid fetuin-A concentration ≤ 19.12 ng/mL had a sensitivity and specificity of 94.74% and 93.1%, respectively, at predicting clinical pregnancy. While the follicular fluid fetuin-B concentration24.7 ng/mL had sensitivity and specificity of 71.1% and 51.7%, respectively, for clinical pregnancy prediction.Overall, high levels of follicular fluid fetuin-A may be independently associated with unsuccessful IVF irrespective of OR grouping. A low level of follicular fetuin-B was also associated with failed IVF. The sensitivity and specificity were found to be higher for fetuin-A in predicting clinical pregnancy. Therefore, the follicular fluid fetuin-A may be more predictive for successful IVF and clinical pregnancy outcomes than follicular fluid fetuin-B.

Patients with emerging anosmia may be asymptomatic carriers of coronavirus disease 2019 infection requiring self-isolation; otherwise, there are risks of facilitating the spread of the disease.This study aims to evaluate the loss of smell with visual analogue scale and to determine the relationship between the loss of smell and blood parameters.All patients' coronavirus disease 2019 swab cultures were polymerase chain reaction positive and pneumonia was found in computed tomographies consistent with oronavirus disease 2019. The study was conducted on 114 patients hospitalized between 01.11.2020 and 31.12.2020 in the Otorhinolaryngology coronavirus disease 2019 Service of University of Health Sciences Adana City Training and Research Hospital and followed up by us.A score of 10 indicates that the olfactory function is completely normal in all patients undergoing visual analogue scale, and a score of 0 indicates that they cannot smell anything. Patients who received visual analogue scale scored 10 points were categorized as Group 1 and others as Group 2. Statistical significance level was determined as p < 0.05. A statistically significant difference was found between Group 1 and Group 2 in terms of visual analogue scale smell score, neutrophil, lymphocyte, neutrophil-lymphocyte ratio. Visual analogue scale smell score, neutrophil count, neutrophil-lymphocyte ratio value were found to be lower in Group 2 and lymphocyte count was found to be higher. Neutrophil, lymphocyte, neutrophil/lymphocyte ratio, platelet, platelet/lymphocyte ratio, which are also used in nasal diseases, may be used to detect loss of smell, predict, and even determine the prognosis of loss of smell if supported by further studies.

Background Compared with the general population, the risk of death is substantially higher in renal transplant recipients than in age- and sex-matched individuals in the general population. In the general population, coronary artery calcification (CAC) predicts all-cause and cardiovascular mortality. In this study we aimed to analyse these relationships in renal transplant recipients. Methods We examined 178 renal transplant patients in this prospective observational cohort study. We measured CAC with multidetector spiral computed tomography using the Agatston score at multiple time points. Overall, 411 scans were performed in 178 patients over an average 12.8 years follow-up. The clinical endpoint was a composite including all-cause death and non-fatal cardiovascular events. Data analysis was performed by the joint model. Results During a follow-up of 12.8 ± 2.4 years, coronary calcification progressed over time (P, GRAPHICAL ABSTRACT Graphical Abstract

To determine the widths of fallopian canal segments (labyrinthine segment, geniculate ganglion, tympanic segment mastoid segment and stylomastoid foramen), in two nations with different ethnic origins, and to analyze the differences in between.We retrospectively analyzed temporal computerized tomographies of 102 individuals including 38 Turks and 64 Syrians. The widths of right and left labyrinthine (LS), tympanic (TS), mastoid (MS), geniculate ganglion (GG) and stylomastoid foramen (SF) segments of the fallopian canal were measured.The narrowest segment was LS (right: 1.04 ± 0.23 mm, left: 1.03 ± 0.22 mm) and the widest segment was SF (right: 1.82 ± 0.41 mm, left: 1.85 ± 0.35 mm). From the widest to the narrowest, the widths of the FC segments were sorted as SF GG MS TS LS. The widths of the fallopian canal segments were similar between right and left sides, and between males and females (p 0.05). Our results indicated that both right and left GG were significantly wider in Turks (p 0.001 for both), however right LS (p 0.001) and left TS (p = 0.005) were significantly wider in Syrian refugees. Two groups did not show any differences for the widths of other FC segments (p 0.05).Nations of different ethnic origins may have differences concerning the widths of some segments of the fallopian canal. Further studies with a larger sample size including clinical data of the patients are needed to clarify our findings, and to determine whether these differences have any clinical implications.

BACKGROUND Current lung cancer risk-based screening approaches use a single risk-threshold, disregard life-expectancy, and ignore past screening findings. We address these limitations with a comprehensive analytical framework, the individualized lung cancer screening decision (ENGAGE) tool that aims to optimize lung cancer screening for US ever-smokers under dynamic risk assessment by incorporating life expectancy and past screening findings over time. METHODS ENGAGE employs a partially observable Markov decision process framework that integrates published risk prediction and disease progression models, to dynamically assess the trade-off between the expected health benefits and harms associated with screening. ENGAGE evaluates lung cancer risk annually and provides real-time screening eligibility that maximizes the expected quality-adjusted life-years (QALYs) of ever-smokers. We compare ENGAGE against the 2013 U.S. Preventive Services Task Force (USPSTF) lung cancer screening guideline and single-threshold risk-based screening paradigms. RESULTS Compared with the 2013 USPSTF guidelines, ENGAGE expands screening coverage among ever-smokers (ENGAGE: 78%, USPSTF: 61%), while reducing the number of screening examinations per person (ENGAGE:10.43, USPSTF:12.07, P

Background A paucity of research addresses breast cancer screening strategies for women at lower-than-average breast cancer risk. The aim of this study was to examine screening harms and benefits among women aged 50-74 years at lower-than-average breast cancer risk by breast density. Methods Three well-established, validated Cancer Intervention and Surveillance Network models were used to estimate the lifetime benefits and harms of different screening scenarios, varying by screening interval (biennial, triennial). Breast cancer deaths averted, life-years and quality-adjusted life-years gained, false-positives, benign biopsies, and overdiagnosis were assessed by relative risk (RR) level (0.6, 0.7, 0.85, 1 [average risk]) and breast density category, for US women born in 1970. Results Screening benefits decreased proportionally with decreasing risk and with lower breast density. False-positives, unnecessary biopsies, and the percentage overdiagnosis also varied substantially by breast density category; false-positives and unnecessary biopsies were highest in the heterogeneously dense category. For women with fatty or scattered fibroglandular breast density and a relative risk of no more than 0.85, the additional deaths averted and life-years gained were small with biennial vs triennial screening. For these groups, undergoing 4 additional screens (screening biennially [13 screens] vs triennially [9 screens]) averted no more than 1 additional breast cancer death and gained no more than 16 life-years and no more than 10 quality-adjusted life-years per 1000 women but resulted in up to 232 more false-positives per 1000 women. Conclusion Triennial screening from age 50 to 74 years may be a reasonable screening strategy for women with lower-than-average breast cancer risk and fatty or scattered fibroglandular breast density.

The aim of our study was to determine the anatomical variations detected on computed tomography radiological imaging of the paranasal sinus between citizens and refugees patient groups and to reveal the differences between the two patient groups. In this study, the data from the files of 38 Turkish Citizens (Group 1), 41 Syrian Refugees (Group 2), a total of 79 patients who were admitted to the ENT Clinic of Adana City Training and Research Hospital due to rhinological complaints between 01.01.2019 and 01.01.2020 and had paranasal sinus tomography, were analyzed retrospectively. Due to the Syrian Civil War that started in 2011, more than 10 million Syrian have left their countries and immigrated to neighboring countries as refugees. The paranasal sinus area has a wide variety of variations. Congenital anomalies and normal anatomical variations in this area are important, although rarely, as they may have pathological consequences or may be a source of difficulty during surgery. In the study, 38 of 79 patients were in Group 1 (48.1%) and 41 were in Group 2 (51.9%). Of the patients, 30 were female (38%) and 49 were male (62%). The ages of the patients ranged from 9 to 78 years, with a mean age of 32.52 years. In our study, we could not find a statistically significant difference between Turkish Citizens and Syrian refugees in terms of anatomical variations detected on paranasal radiological imaging. We consider the number of patients in our study as a limitation of our study and we think that it is important to conduct studies with larger populations

Greenhouse horticulture (protected cropping) is essential in meeting increasing global food demand under climate change scenarios by ensuring sustainability, efficiency, and productivity. Recent advances in cover materials and photovoltaic technologies have been widely examined in greenhouses to improve light transmission and solar energy capture with promoting energy-saving. We review the studies on advanced greenhouse cover materials with variable light transmittance, the effects of which on leaf photosynthesis, physiology, and yield. We provide insights into the potential key biological processes of crops responding to these light changes, specifically light receptors, signal transduction, nutrient biosynthesis pathways (e.g., carotenoids, antioxidant compounds) during fruit development and ripening. A better understanding of greenhouse cover materials with a focus towards energy-efficient cover materials equipped in greenhouse is an opportunity for better yield and higher nutrient products production in vegetables in response to global climate challenges. Interdisciplinary research on the application of novel cover materials in greenhouses and biological investigation of light-induced physiology and nutrient formation in vegetables may promote yield and health attributes for protected cultivation of vegetables with energy use efficiency.

As Covid-19 lockdown forced firms to organize work differently, for example, managing people remotely. Despite the benefits may a firm obtain in adopting new business tools like remote management, but providing assurance that internal control function in an efficient manner is important for a firm; that is because there is a growing interest in internal control issues. It is very important to determine how the remote working model, which emerged during the Covid 19 pandemic process, has changed the accounting processes of businesses. The aim of this study is to propose an internal control model under factors such as remote management, risk assessment, control activities, information and communication, and observation. The data in the research were obtained from the experts in our sample by using the survey method. Our sample consists of managers, supervisors, and academics. The data obtained were evaluated with the Smart-PLS version 3.2.9 program. Findings highlight a positive relationship between control activities and remote management.

To asses the course of intraocular pressure (IOP) restoration and visual acuity (VA) recovery in eyes with hypotony after trabeculectomy.Medical charts of patients undergoing trabeculectomy between January 2017 and June 2019 were reviewed. Cases with hypotony (IOP 5 mmHg) due to over-filtration in the early postoperative period were assessed retrospectively. Primary outcome measures included change in IOP and VA in the postoperative period and percentage of eyes with hypotony on each follow-up.Thirty-five eyes of 31 patients (23 male, 8 female) were included. The mean follow-up was 18.3 ± 6.9 months. The mean IOP was 3.0 ± 3.2, 9.2 ± 6.2, 9.4 ± 5.6, 9.4 ± 4.0, 10.9 ± 3.6 and 10.2 ± 3.3 mmHg at week 1, months 1, 3, 6, 12 and last follow-up, respectively. Out of 35 hypotonic eyes, 8 (22.8%) had prolonged hypotony at month 1, 4 (11.4%) at month 3, 1 (2.9%) at month 6. The decrease in VA continued to be significant at months 1 and 3 (p = 0.015, p = 0.036, respectively) and returned to baseline after the sixth month (p 0.524).In eyes with early hypotony after trabeculectomy while low IOP recovers at first month, it takes longer for the visual restoration. The postoperative month 1 appears to be decisive for recovery of hypotony.

Objective A recent study reported a tuberculosis (TB) outbreak in which, among newly infected individuals, exposure to additional active infections was associated with a higher probability of developing active disease. Referred to as complex contagion, multiple reexposures to TB within a short period after initial infection is hypothesized to confer a greater likelihood of developing active infection in 1 y. The purpose of this article is to develop and validate an agent-based simulation model (ABM) to study the effect of complex contagion on population-level TB transmission dynamics. Methods We built an ABM of a TB epidemic using data from a series of outbreaks recorded in the 20th century in Saskatchewan, Canada. We fit 3 dynamical schemes: base, with no complex contagion; additive, in which each reexposure confers an independent risk of activated infection; and threshold, in which a small number of reexposures confers a low risk and a high number of reexposures confers a high risk of activation. Results We find that the base model fits the mortality and incidence output targets best, followed by the threshold and then the additive models. The threshold model fits the incidence better than the base model does but overestimates mortality. All 3 models produce qualitatively realistic epidemic curves. Conclusion We find that complex contagion qualitatively changes the trajectory of a TB epidemic, although data from a high-incidence setting are reproduced better with the base model. Results from this model demonstrate the feasibility of using ABM to capture nuances in TB transmission.

Introduction: Malignant tumors of the skin include basal cell carcinoma, squamous cell carcinoma, malignant melanoma and tumors of the skin appendages.Skin lesions in the head and neck region are frequently encountered in the geriatric population. Although these lesions are generally benign, it is widely known that the prevalence of malignant lesions increases with age.In adults, 80% of the masses in the neck, except benign thyroid diseases, are of neoplastic origin and this rate reaches 90% after the 5th decade. About 70% of these neoplastic masses are malignant, and three-quarters of these are metastatic and one-fourth is primary malignancies. Objectives: Increasing world population, increasing survival time and increasing geriatric patient population create some differences in healthcare. We planned this study for this purpose. Methods: The data of 73 patients aged 65 and over were retrospectively analyzed. Patients were divided into two groups as 65-75 years old (Group 1), > 75 years old (Group 2), by age. Results: Premalignant lesions were found to be statistically significantly higher in Group 1 (p

BACKGROUND: Across the United States, various social distancing measures were implemented to control the spread of coronavirus disease 2019 (COVID-19). However, the effectiveness of such measures for specific regions with varying population demographic characteristics and different levels of adherence to social distancing is uncertain. OBJECTIVE: To determine the effect of social distancing measures in unique regions. DESIGN: An agent-based simulation model. SETTING: Agent-based model applied to Dane County, Wisconsin; the Milwaukee metropolitan (metro) area; and New York City (NYC). PATIENTS: Synthetic population at different ages. INTERVENTION: Different times for implementing and easing social distancing measures at different levels of adherence. MEASUREMENTS: The model represented the social network and interactions among persons in a region, considering population demographic characteristics, limited testing availability, "imported" infections, asymptomatic disease transmission, and age-specific adherence to social distancing measures. The primary outcome was the total number of confirmed COVID-19 cases. RESULTS: The timing of and adherence to social distancing had a major effect on COVID-19 occurrence. In NYC, implementing social distancing measures 1 week earlier would have reduced the total number of confirmed cases from 203 261 to 41 366 as of 31 May 2020, whereas a 1-week delay could have increased the number of confirmed cases to 1 407 600. A delay in implementation had a differential effect on the number of cases in the Milwaukee metro area versus Dane County, indicating that the effect of social distancing measures varies even within the same state. LIMITATION: The effect of weather conditions on transmission dynamics was not considered. CONCLUSION: The timing of implementing and easing social distancing measures has major effects on the number of COVID-19 cases. PRIMARY FUNDING SOURCE: National Institute of Allergy and Infectious Diseases.

Objective: We aimed to determine the efficacy of rapid antigen tests, clinical signs, and McIsaac / modified Centor clinical scoring systems in the diagnosis of Group A streptococcus (GAS) at children.Materials and Methods: Subjects aged 3-14 years who presented with acute tonsillopharyngitis were questioned about their sociodemographic properties and symptoms. Their clinical signs and McIsaac / modified Centor scores were recorded. They underwent a rapid streptococcal antigen test and throat culture sampling.Results: GAS proliferated in culture %11 of cases. The risk of culture positivity was 4.8 times greater in children aged 6 years or older. There was a significant correlation between culture positivity and muscle pain, tonsillar edema. Rapid strep test had a sensitivity of 75% and a specifity of 100% for the diagnosis of streptococcal tonsillopharyngitis. Rapid strep test showed a sensitivity of 80% and a specifity of 100% in children with a McIsaac / modified Centor score of 4-5.Conclusions: Unnecessary antibiotic use for tonsillopharyngitis is an important problem. Therefore, it is ideal to order throat culture and act accordingly in every case suggesting GAS infection. However, when culture is not possible, rapid strep testing and McIsaac / modified Centor scoring are effective in guiding diagnosis and treatment., Amaç: Bu çalışmada çocuklarda grup A streptokok (GAS) infeksiyonlarını saptamada hızlı antijen testi, klinik bulgular ile McIsaac / modifiye Centor klinik skorlamalarının etkinliğinin saptanması amaçlandı.Materyal ve Metot: Çalışmada akut tonsillofarenjitle başvuran 3-14 yaş arası olgular sosyodemografik ve semptomlar yönünden sorgulandı. Klinik bulguları ve McIsaac / modifiye Centor skorlamaları kaydedildi. Olguların tümüne hızlı streptokok antijen testi uygulandı ve boğaz kültürü çalışıldı. Bulgular: Olguların % 11 inde GAS kültürde üredi. Altı yaş ve üzeri çocuklarda kültür pozitifliği riski 4.8 kat daha fazla saptandı. Kas ağrısı ve tonsiller ödem ile kültür pozitifliği arasında istatiksel anlamlı ilişki mevcuttu Hızlı antijen testi streptokok tonsillofarenjiti tanısında %75 duyarlılığa, %100 özgüllüğe sahip olarak bulundu. McIsaac / modifiye Centor skoru 4-5 olan çocuklarda hızlı antijen testi streptokok tonsillofarenjiti tanısında %80 duyarlılık, %100 özgüllük gösterdi. Sonuç: Akut tonsillofarenjitte gereksiz antibiyotik kullanımı önemli bir sorundur. Bu nedenle GAS infeksiyonunu düşündüren her olguda boğaz kültürünün istenmesi ve ona göre hareket edilmesi ideal olandır. Ancak kültürün yapılamadığı durumlarda tanı ve tedaviyi yönlendirmede hızlı strep testi ve McIsaac / modifiye Centor skorlaması etkilidir.

Purpose: To evaluate the prescribing habits of glaucoma specialists and of general ophthalmologists, and reveal the conformance with European Glaucoma Society (EGS) guidelines in the medical treatm...

Objective:The aim of this study was to detect a prostate specific antigen (PSA) cut-off value for metastases, and prevent unnecessary use of Ga-68 prostate specific membrane antigen (PSMA) ligand positron emission tomography/computer tomography (CT) imaging.Materials and Methods:Between January 2016 and October 2017, patients with prostate cancer (PCa) who were staged using Ga-68 PSMA enrolled in this retrospective study. Patients were divided into two groups: group 1 (G1) had Ga-68 PSMA for primary staging, and group 2 (G2) had Ga-68 PSMA for detection of metastases after treatment (secondary staging). PSA cut-off values were calculated for general, bone, lymph node and visceral metastases.Results:A total of 181 patients were included in this study. PSA cut-off was 7.5 ng/mL for overall metastases in general. The PSA cut-offs for overall metastases using initial PSA were 8.98 ng/mL and 6.82 ng/mL for G1 and G2, respectively. For G2 patients the post-treatment PSA cut-off was 0.38 ng/mL. For bone metastases, the PSA cut-offs using initial PSA were 8.98 ng/mL and 10.7 ng/mL for G1 and G2, respectively. For lymph node metastases, the PSA cut-offs using initial PSA were 8.98 ng/mL and 6.71 ng/mL for G1 and G2, respectively. For visceral metastases, the PSA cut-offs using initial PSA were 16.4 ng/mL and 7.08 ng/ mL for G1 and G2, respectively. The same analyses could not be calculated in subgroups of G2 due to small sample size.Conclusion:These cut-off values do not suggest that Ga-68 PSMA is superior to using both CT and bone scintigraphy. It is an expensive test and its use is only reasonable when small lymph node metastases cannot be evaluated in CT.

Background Surveillance with annual mammography and breast magnetic resonance imaging (MRI) is recommended for female survivors of childhood cancer treated with chest radiation, yet benefits, harms, and costs are uncertain. Objective To compare the benefits, harms, and cost-effectiveness of breast cancer screening strategies in childhood cancer survivors. Design Collaborative simulation modeling using 2 Cancer Intervention and Surveillance Modeling Network breast cancer models. Data sources Childhood Cancer Survivor Study and published data. Target population Women aged 20 years with a history of chest radiotherapy. Time horizon Lifetime. Perspective Payer. Intervention Annual MRI with or without mammography, starting at age 25, 30, or 35 years. Outcome measures Breast cancer deaths averted, false-positive screening results, benign biopsy results, and incremental cost-effectiveness ratios (ICERs). Results of base-case analysis Lifetime breast cancer mortality risk without screening was 10% to 11% across models. Compared with no screening, starting at age 25 years, annual mammography with MRI averted the most deaths (56% to 71%) and annual MRI (without mammography) averted 56% to 62%. Both strategies had the most screening tests, false-positive screening results, and benign biopsy results. For an ICER threshold of less than $100 000 per quality-adjusted life-year gained, screening beginning at age 30 years was preferred. Results of sensitivity analysis Assuming lower screening performance, the benefit of adding mammography to MRI increased in both models, although the conclusions about preferred starting age remained unchanged. Limitation Elevated breast cancer risk was based on survivors diagnosed with childhood cancer between 1970 and 1986. Conclusion Early initiation (at ages 25 to 30 years) of annual breast cancer screening with MRI, with or without mammography, might reduce breast cancer mortality by half or more in survivors of childhood cancer. Primary funding source American Cancer Society and National Institutes of Health.

Glucose-6-phosphate dehydrogenase (G6PD) deficiency is an X-linked recessive disease that causes acute or chronic hemolytic anemia and potentially leads to severe jaundice in response to oxidative agents. Capicua transcriptional repressor (CIC) is an important gene associated with mental retardation, autosomal dominant 45. Affiliated tissues including skin, brain, bone, and related phenotypes are intellectual disability and seizures. Clinical, biochemical, and whole exome analysis are carried out in a Turkish family. Mutation analysis of G6PD and CIC genes by Sanger sequencing in the whole family was carried out to reveal the effect of these mutations on the patient's clinical outcome. Here, we present the case of epilepsy in an 8-year-old child with a hemizygous variation in G6PD gene and heterozygous mutation in CIC gene, resulting in focal epileptiform activity and hypsarrhythmia in electroencephalography (EEG), seizures, psychomotor retardation, speech impairment, intellectual disability, developmental regression, and learning difficulties. Whole exome sequencing confirmed the diagnosis of X-linked increased susceptibility for hemolytic anemia due to G6PD deficiency and mental retardation type 45 due to CIC variant, which explained the development of epileptic seizures. Considering CIC variant and relevant relation with the severity and course of the disease, G6PD mutations sustained through the family are defined as hereditary. Our findings could represent the importance of variants found in G6PD as well as CIC genes linked to the severity of epilepsy, which was presumed based on the significant changes in protein configuration.

Objective:Neutrophil gelatinase-associated lipocalin (NGAL) has been reported as an useful marker to detect early contrast-induced acute kidney injury (CI-AKI). However most of the studies were performed in subjects taking intraarterial contrast. We aimed to evaluate the role of serum NGAL for detection of CI-AKI in patients undergoing contrast-enhanced computed tomography (CT).Methods:We prospectively enrolled consecutive hospitalized patients with estimated glomerular filtration rate ≥15 mL/min/1.73m2 undergoing contrast enhanced CT. Blood samples were taken before (baseline) and after 4 hours following procedure for NGAL and for serum creatinine (SCr) 12-24 hours prior to CT and again 48 hours after administration of contrast agent. The primary outcome of the study was the development of CI-AKI.Results:A total of 70 (male, 50%) subjects with a mean age of 61.1±16.1 years were enrolled. The mean baseline SCr was 1.02±0.39mg/dL. The incidence of CI-AKI was 5.7%. In the whole group serum NGAL decreased from median 119.7 (IQR, 126.3) ng/mL at baseline to median 87.3 (interquartile range, 72.9) ng/mL after contrast application. Subjects were classified into those with and without CI-AKI. Subjects with CI-AKI did not differ in baseline demographics, renal function, presence of systemic disorders and serum NGAL levels (baseline and 4 h) compared with those without CI-AKI.Conclusion:In conclusion, 4 h measurement of serum NGAL does not seem a useful marker for the early detection of CI-AKI following IV contrast administration.

Işığın dalga doğası nedeniyle, harmonik analiz (Fourier dönüşümü) ve süperpozisyon, optik sistemlerin ve Fourier optik deneylerinin analiz ve tasarımında kullanılmaktadır. Bu çalışma, optik uzaysal filtrelerin sonuçlarının benzetimini için hızlı Fourier dönüşümü hesaplamalarının kullanımını göstermeyi amaçlamaktadır. Fourier optik deneylerini veya cihazlarını tasarlamak için bilgisayar simülasyonu yapmak ve teorik sonuçlar elde etmek oldukça faydalıdır. Bu çalışmada, alçak geçiren ve yüksek geçiren optik uzaysal filtre düzenekleri için hızlı Fourier dönüşümü tabanlı simülasyonlar Matlab ortamında gerçekleştirilmiş ve çalışmada bu simülasyonların sonuçları rapor edilmiştir. Sonuçlar, simülasyon yönteminin optik eğitimine ek olarak optik uzaysal filtrelerin tasarımı ve analizi için kullanılabileceğini göstermiştir., Due to wave nature of the light, harmonic analysis (Fourier transform) and superposition are used in analysis and design of optical systems and Fourier optics experiments. This study aims to illustrate use of fast Fourier transform computations in order to simulate optical spatial filter results. In order to design Fourier optics experiments or devices, it is quite useful to perform computer simulation and obtain theoretical results. In this study, fast Fourier transform based simulations for low-pass and high-pass optical spatial filter setups are carried out in Matlab environment and results of these simulations are report. Results indicate that this simulation method can be used for the design and analysis of optical spatial filters in addition to the optics education.

Overdiagnosis of breast cancer, defined as diagnosing a cancer that would otherwise not cause symptoms or death in a patient's lifetime, costs U.S. health care system over $1.2 billion annually. Overdiagnosis rates, estimated to be around 10%-40%, may be reduced if indolent breast findings can be identified and followed with noninvasive imaging rather than biopsy. However, there are no validated guidelines for radiologists to decide when to choose imaging options recognizing cancer grades and types. The aim of this study is to optimize breast cancer diagnostic decisions based on cancer types using a large-scale finite-horizon Markov decision process (MDP) model with 4.6 million states to help reduce overdiagnosis. We prove the optimality of a divide-and-search algorithm that relies on tight upper bounds on the optimal decision thresholds to find an exact optimal solution. We project the high-dimensional MDP onto two lower dimensional MDPs and obtain feasible upper bounds on the optimal decision thresholds. We use real data from two private mammography databases and demonstrate our model performance through a previously validated simulation model that has been used by the policy makers to set the national screening guidelines in the United States. We find that a decision-analytical framework optimizing diagnostic decisions while accounting for breast cancer types has a strong potential to improve the quality of life and alleviate the immense costs of overdiagnosis. Our model leads to a 20%$20\%$ reduction in overdiagnosis on the screening population, which translates into an annual savings of approximately $300 million for the U.S. health care system. National Cancer Institute [K24CA194251, P30CA014520, R01CA165229] Published version National Cancer Institute, Grant/Award Numbers: K24CA194251, P30CA014520, R01CA165229

Background Early initiation of breast cancer screening is recommended for high-risk women, including survivors of childhood cancer treated with chest radiation. Recent studies suggest that female survivors of childhood leukemia or sarcoma treated without chest radiation are also at elevated early onset breast cancer risk. However, the potential clinical benefits and cost-effectiveness of early breast cancer screening among these women are uncertain. Methods Using data from the Childhood Cancer Survivor Study, we adapted 2 Cancer Intervention and Surveillance Modeling Network simulation models to reflect the elevated risks of breast cancer and competing mortality among leukemia and sarcoma survivors. Costs and utility weights were based on published studies and databases. Outcomes included breast cancer deaths averted, false-positive screening results, benign biopsies, and incremental cost-effectiveness ratios. Results In the absence of screening, the lifetime risk of dying from breast cancer among survivors was 6.8% to 7.0% across models. Early initiation of annual mammography with breast magnetic resonance imaging screening between ages 25 and 40 years would avert 52.6% to 64.3% of breast cancer deaths. When costs and quality-of-life impacts were considered, screening starting at age 40 years was the only strategy with an incremental cost-effectiveness ratio below the $100 000 per quality-adjusted life-year (QALY) gained cost-effectiveness threshold ($27 680 to $44 380 per QALY gained across models). Conclusions Among survivors of childhood leukemia or sarcoma, early initiation of breast cancer screening at age 40 years may reduce breast cancer deaths by half and is cost-effective. These findings could help inform screening guidelines for survivors treated without chest radiation.

Evaluate cost-effectiveness of telehealth with remote monitoring for postpartum hypertensive disorders from the hospital's perspective.A decision tree was developed using results from a non-randomized controlled trial comparing telehealth to standard outpatient blood pressure monitoring. At discharge, postpartum women with a hypertensive disorder received a Bluetooth tablet, blood pressure monitor, and scale to submit vitals daily for 6 weeks. Women were managed and treated with a standard protocol. We performed a cost-effectiveness analysis using data from the hospital, device manufacturer supplied charges, and utilities. A cost-effectiveness threshold was set at $100,000/quality-adjusted life years. One-way and two-way sensitivity analyses were performed to evaluate the robustness of our results compared to baseline assumptions.Telehealth monitoring significantly reduced postpartum readmissions, 3.7% (8/214) versus 0.5% (1/214), and resulted in higher quality-adjusted life years. Telehealth monitoring was cost-effective and cost-saving. Average cost of telehealth per patient was $309, and was cost-effective to a cost of $420 per patient. Telehealth monitoring remained cost-effective down to an admission cost of $10,999 compared to our baseline-estimate for the average admission cost of $14,401. Telehealth monitoring also remained cost-effective when the postpartum readmission rate was 3.0% or higher with standard monitoring. With a cost saving of $93 per patient and an estimated 333,253 pregnant women with hypertension in the US a year, telehealth could reduce health care costs in the US by approximately $31 million a year.This study demonstrates telehealth with remote blood pressure monitoring may be a cost-effective and cost-saving solution for management of postpartum hypertension.

Aims Flavonoids and related compounds, such as quercetin‐based antiviral drug Gene‐Eden‐VIR/Novirin, inhibit the protease of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2). The alkylated chalcones isolated from Angelica keiskei inhibit SARS‐CoV proteases. In this study, we aimed to compare the anti‐SARS CoV‐2 activities of both newly synthesized chalcone derivatives and these two drugs. Methods Determination of the potent antiviral activity of newly synthesized chalcone derivatives against SARS‐CoV‐2 by calculating the RT‐PCR cycling threshold (Ct ) values. Results Antiviral activities of the compounds varied because of being dose dependent. Compound 6, 7, 9, and 16 were highly effective against SARS‐CoV‐2 at the concentration of 1.60 µg/mL. Structure‐based virtual screening was carried out against the most important druggable SARS‐CoV‐2 targets, viral RNA‐dependent RNA polymerase, to identify putative inhibitors that could facilitate the development of potential anti‐coronavirus disease‐2019 drug candidates. Conclusions Computational analyses identified eight compounds inhibiting each target, with binding affinity scores ranging from −4.370 to −2.748 kcal/mol along with their toxicological, ADME, and drug‐like properties.

Objective:Clostridioides difficile infection (CDI) is rapidly increasing in children’s hospitals nationwide. Thus, we aimed to compare the effectiveness of 9 infection prevention interventions and 6 multiple-intervention bundles at reducing hospital-onset CDI and asymptomatic C. difficile colonization.Design:Agent-based simulation model of C. difficile transmission.Setting:Computer-simulated, 80-bed freestanding, tertiary-care pediatric hospital, including 8 identical wards with 10 single-bed patient rooms each.Participants:The model includes 5 distinct agent types: patients, visitors, caregivers, nurses, and physicians.Interventions:Daily and terminal environmental disinfection, screening at admission, reduced intrahospital patient transfers, healthcare worker (HCW), visitor, and patient hand hygiene, and HCW and visitor contact precautions.Results:The model predicted that daily environmental disinfection with sporicidal product, combined with screening for asymptomatic C. difficile at admission, was the most effective 2-pronged infection prevention bundle, reducing hospital-onset CDI by 62.0% and asymptomatic colonization by 88.4%. Single-intervention strategies, including daily disinfection, terminal disinfection, asymptomatic screening at admission, HCW hand hygiene, and patient hand hygiene, as well as decreasing intrahospital patient transfers, all also reduced both hospital-onset CDI and asymptomatic colonization in the model. Visitor hand hygiene and visitor and HCW contact precautions were not effective at reducing either measure.Conclusions:Hospitals can achieve substantial reduction in hospital-onset CDIs by implementing a small number of highly effective interventions.

Background Digital breast tomosynthesis (DBT) is increasingly being used for routine breast cancer screening. We projected the long-term impact and cost-effectiveness of DBT compared to conventional digital mammography (DM) for breast cancer screening in the United States. Methods Three Cancer Intervention and Surveillance Modeling Network breast cancer models simulated US women ages 40 years and older undergoing breast cancer screening with either DBT or DM starting in 2011 and continuing for the lifetime of the cohort. Screening performance estimates were based on observational data; in an alternative scenario, we assumed 4% higher sensitivity for DBT. Analyses used federal payer perspective; costs and utilities were discounted at 3% annually. Outcomes included breast cancer deaths, quality-adjusted life-years (QALYs), false-positive examinations, costs, and incremental cost-effectiveness ratios (ICERs). Results Compared to DM, DBT screening resulted in a slight reduction in breast cancer deaths (range across models 0–0.21 per 1000 women), small increase in QALYs (1.97–3.27 per 1000 women), and a 24–28% reduction in false-positive exams (237–268 per 1000 women) relative to DM. ICERs ranged from $195 026 to $270 135 per QALY for DBT relative to DM. When assuming 4% higher DBT sensitivity, ICERs decreased to $130 533–$156 624 per QALY. ICERs were sensitive to DBT costs, decreasing to $78 731 to $168 883 and $52 918 to $118 048 when the additional cost of DBT was reduced to $36 and $26 (from baseline of $56), respectively. Conclusion DBT reduces false-positive exams while achieving similar or slightly improved health benefits. At current reimbursement rates, the additional costs of DBT screening are likely high relative to the benefits gained; however, DBT could be cost-effective at lower screening costs.

BACKGROUND This study evaluated the effect of bilateral endoscopic sphenopalatine ganglion block (SPGB) for management of postoperative pain in patients undergoing septoplasty. METHODS Sixty septoplasty patients (51.7% male, 48.3% female, aged 18 to 45 years) were randomly assigned to general anesthesia (GA) alone (control) (n = 30) or GA plus endoscopic SPGB (n = 30). Demographic data, duration of surgery, blood loss, postoperative visual analogue scale (VAS) pain scores (upon arrival at the postanesthesia care unit [PACU] and 2, 6, 12, and 24 hours after surgery), overall analgesic usage (end of 24 and 168 hours after surgery), overall satisfaction with the pain control (end of 24 and 168 hours after surgery), and complications (bleeding, nausea and vomiting, and visual disturbance) were recorded. RESULTS Pain scores upon arrival to the PACU and 2, 6, 12, and 24 hours after surgery were significantly lower in the SPGB group compared to the control group (p < 0.001). Moreover, the SPGB group had significantly lower analgesic requirements and higher satisfaction scores with their pain control at the end of 24 and 168 hours after surgery compared to the control group (p < 0.001). The 2 groups significantly differed in terms of intraoperative blood loss (p = 0.024), and surgery time was longer in the SPGB group compared to the control group (p < 0.001). CONCLUSION SPGB with bupivacaine is a safe and effective method to reduce pain after septoplasty, and it is a cost-effective alternative to high doses of analgesics.

Objective Persistence of abnormalities in mineral metabolism is common after kidney transplantation and appears to have a negative effect on survival. We aimed to evaluate the mineral metabolism and identify risk factors for persistent hyperparathyroidism (HPT) over 10 years. Methods We retrospectively analyzed the medical records of 176 consecutive renal transplant patients. Serum creatinine, calcium, phosphorus, and intact parathyroid hormone (iPTH) levels before and after transplantation up to the 10th year post transplantation were recorded for 11 different dates. Calcium > 10.2 mg/dL was considered hypercalcemia, phosphorus 2.5 times the upper limit was considered HPT. Results After a major fall in the first 3 months, iPTH steadily decreased over 5 years. Thereafter, it stabilized at a level of 1.5 times the upper limit. Rates of persistent HPT were 9.2% and 10.7% in the fifth and 10th years, respectively. The rate of hypercalcemia increased up to 21.7% at the ninth month, and after 10 years, it was 5.9%. The rate of hypophosphatemia peaked at 33.3% in the first month, and it was 8.9% in 10th year. Multivariate analysis revealed that calcium (P = .047) and phosphorus (P = .041) at the time of transplantation and female sex (P = .037) were independent predictors of persistent HPT in the first year. iPTH correlated significantly with kidney function and pre-transplant iPTH. Conclusions High serum levels of iPTH, calcium, and phosphorus at the time of transplantation were risk factors for persistent HPT in kidney transplant recipients, especially when renal function was suboptimal.

Women with Down syndrome have a lower breast cancer risk and significantly lower life expectancies than women without Down syndrome. Therefore, it is not clear whether mammography screening strategies used for women without Down syndrome would benefit women with Down syndrome in the same way. To determine the benefits and harms of various mammography screening strategies for women with Down syndrome using collaborative simulation modeling. Two established Cancer Intervention and Surveillance Modeling Network (CISNET) simulation models estimated the benefits and harms of various screening strategies for women with Down syndrome over a lifetime horizon. We modeled a hypothetical cohort of US women with Down syndrome who were born in 1970. Annual, biennial, triennial, and one-time digital mammography screenings during the ages 40–74. The models estimated numbers of mammograms, false-positives, benign biopsies, breast cancer deaths prevented, and life-years gained per 1000 screened women when compared with no screening. In average-risk women 50–74, biennial screening incurred 122 mammograms, 10 false-positive mammograms, and 1.4 benign biopsies per one life-year gained compared with no screening. In women with Down syndrome, the same screening strategy incurred 2752 mammograms, 242 false-positive mammograms, and 34 benign biopsies per one life-year gained compared with no screening. The harm/benefit ratio varied for other screening strategies, and was most favorable for one-time screening at age 50, which incurred 1629 mammograms, 144 false-positive mammograms, and 20 benign biopsies per one life-year gained compared with no screening. The harm/benefit ratios for various mammography screening strategies in women with Down syndrome are not as favorable as those for average-risk women. The benefit of screening mammography for women with Down syndrome is less pronounced due to lower breast cancer risk and shorter life expectancy.

The Internet of Things (IoT) contains a diverse set of sensors, actuators and other Internet-connected devices communicating, processing data and performing a multitude of functions. It is emerging as an integral part of societal infrastructure enabling smart services. However, these connected objects might have various vulnerabilities that can lead to serious security compromises and breaches. Securing and hardening of IoT systems is thus of vital importance. In that regard, attack graphs provide analytical support to prevent multistep network attacks by showing all possible sequences of vulnerabilities and their interactions. Since attack graphs generally consist of a very large number of nodes, it is computationally challenging to analyze them for network hardening. In this paper, we propose a greedy algorithm using compact attack graphs to find a cost-effective solution to protect IoT systems. First, we extract all possible attack paths which reach predetermined critical resources embedded in the network. Then, exploit or initial condition with minimum effective cost is selected to be removed. This cost is calculated as a function of contribution to attack paths (the higher, the better) and removal cost (the lower, the better). This process continues iteratively until the total cost exceeds the allocated budget. The experimental results show that our algorithm scales almost linearly with the network size and it can be applied to large-scale graphs with a very large number of IoT nodes. In addition to network-hardening, our proposal measures the security level of the network in every step to demonstrate the vulnerability grade of the system. (C) 2018 Elsevier B.V. All rights reserved.

Background The aim of this study was to evaluate changes in intraocular inflammation according to energy delivered per eye during transscleral diode laser cyclophotocoagulation (TDLC) in refractory glaucoma using laser flare (LF) photometry and to investigate the relationship between the change in anterior chamber flare values ​​and the success of TDLC. Methods Patients who underwent TDLC for refractory glaucoma and had LF photometry data were analyzed retrospectively. We recorded the best-corrected visual acuity, intraocular pressure (IOP) with Goldmann applanation tonometer, number of anti-glaucoma medications, LF photometry values (ph/ms) on pre-and postoperative days 1, 10 and 30. Results The mean laser power applied during TDLC procedure was 2.45±0.35W. The mean laser duration was 2.09±0.28sec. The mean total energy applied per eye was 114.69±16.13 J, the mean number of pulses was 22.43±4.3. While the mean LF value was 49.71±11.99ph/ms preoperatively, it was 63.94±12.41ph/ms at the postoperative 30th day. Possible predictors of success of TDLC were investigated using linear regression analysis (R adjusted 0.454 p=0.001). The IOP decrease at postoperative 30th day was significantly related to the difference between the postoperative 1st day and the preoperative LF (p=0.025, B/95% CI -0.358/-0.107- -0.008), and total cyclodiode energy delivered per eye (joules) (p=0.016, B/95% CI -0.396/-0.287 - -0.031). Conclusions Anterior chamber flare values increases after TDLC, though it does not regress to the preoperative level on the postoperative 30th day. Total cyclodiode energy delivered per eye and the difference between the postoperative 1st day and the preoperative LF can be used to predict TDLC response.

Introduction: Distortion product otoacoustic emission (DPOAE) was measured to investigate the effect of mask use and type on oxygen saturation on cochlear function in health care professionals during the COVID-19 pandemic. Material and Methods: Group 1 participants wore surgical masks; Group 2 participants wore N95 masks. Distortion product otoacoustic emission and oxygen saturation were measured in both groups before and after mask use. Results: Comparison of signal-to-noise ratio (SNR) values before and after surgical mask use in DPOAE measurements of group 1 revealed statistically significant difference in the right and left ears. Comparison of the SNR values in DPOAE measurements of group 2 before and after 8 hours of N95 mask use revealed statistically significant differences in the right ear at 988, 2963, 4444, and 8000 Hz and in the left ear at 8000 Hz. Conclusion: We found that prolonged mask use may affect the outer hair cells in the cochlea, causing deterioration in DPOAE values.

In the present paper, two software implementations of fractional-order proportional-integral-derivative (FOPID) controllers are presented. Both implementations are based on discrete time modeling. One of the implementations is also endowed with a FOPID controller gain tuning algorithm based on knowledge of the dynamics of plant under study, namely a fractional-order first-order plus dead time model. The presented implementations are intended to be used on embedded platforms, including Python-capable devices, but can easily be implemented in a distributed control system (DCS) environment that has C/C++ programming language support. In the paper we reflect on the main ideas behind the implementations and provide two examples produced in a software-in-the-loop (SIL) environment with MATLAB/Simulink implementing the controlled plant and also providing a simulation result for comparison. These examples indicate the validity of the proposed implementations.

X-lined intellectual disability (XLID), formerly known as X-lined mental retardation, is defined as genetically heterogeneous disorders with remarkable cognitive impairment and abnormal adaptive behaviour skills. This study demonstrates the Disc-large homolog 3 (DLG3) gene impairment in 2 different unrelated male probands. The results detected two missense mutations in the DLG3 gene, c.2267 G > A (p.Arg756Gln) and c.2359G > A p. (Gly787Ser) using by NGS. Both mutations were run in the PolyPhen2 program for mutation sensitivity check and showed to have 0.709 and 1, respectively. The familial transmission pattern of MR detected both mothers to be heterozygote. The mutations were shown to have caused non-syndromic XLMR (NS-XLMR) as both males did not show any abnormal facial or physiological features. Based on the IQ measurement, proband 1 and 2’ IQs were measured 40 and 33, and they were diagnosed with moderate and severe XLMR, respectively. Both affected males showed significant deterioration in neural development and behaviour abilities, which indicates the significant impact of the mutation on neurotransmitters and maintenance of NMDA receptors in neural functions. However, further molecular and functional studies are necessary to provide more conclusive evidence of the detailed abnormalities caused by the reported mutations.

Credit risk and default risk are very important concepts for all banks and financial institutions globally. As credit risk measurement and modeling requires working with large samples, it was preferred to use machine learning, one of the modern analysis techniques. In the study, Logistic Regression, Random Forest and Artificial Neural Networks, which are quite common among machine learning algorithms and have taken their place in research, were used for data analysis and modeling studies. 66,078 loan samples and 11 variables belonging to these samples have been used in the modeling, and research has been carried out on the estimation of the results of successful (0) or unsuccessful (1) credits using machine learning algorithms according to the effect of these variables. These records were taken anonymously from the test environment of a financial institution and the necessary data engineering and modeling studies were carried out using the Python programming language. As a result of the study, it was seen that the model established with Logistic Regression produces better results and is a more suitable method for the research subject.

In this work, we systematically studied the temperature dependence of the current–voltage characteristics of Pt/ $$\hbox {NiO}_{{x}}$$ /Pt crossbar-type devices. We find that the resistive memory switching performance of the device can be controlled by temperature. Specifically, devices that do not show resistive switching at room temperature can be made to exhibit this phenomenon after forming stable conductive filaments at low temperatures.

To measure and evaluate the thickness of the retinal nerve fiber layer (RNFL) and ganglion cell-inner plexiform layer (GC-IPL) in patients with Parkinson's disease using optical coherence tomography (OCT).58 eyes of 30 patients with Parkinson's disease and 60 eyes of 30 healthy individuals were enrolled to this study according to defined criteria. RNFL thickness, central macular thickness (CMT) and ganglion cell-inner plexiform layer (GC-IPL) thickness were measured in these groups. The Parkinson's patient group was also subjected to Unified Parkinson's Disease Rating Scale (UPDRS) and Mini Mental Status Exam (MMSE).No difference was found between the two groups with respect to age, sex and the best corrected visual acuity (BCVA). Mean, superior, and inferior quadrant RNFL values in the Parkinson's patients were found statistically significantly lower than those in the control group (P 0.001, P 0.049, P 0.001, respectively). While CMT was statistically similar between the groups, GC-IPL thickness was statistically significantly lower in Parkinson's patients (p = 0.028). There was no significant correlation between the duration of Parkinson's disease and RNFL thickness. While there was not any correlation between UPDRS total and motor scores and superior and temporal quadrant RNFL thicknesses, a significant negative correlation was established between RNFL nasal, inferior quadrant and RNFL mean thicknesses (P = 0.022; P = 0.035; P = 0.002, respectively). A significant positive correlation was found between MMSE and nasal and mean RNFL thicknesses (P = 0.046; P = 0.019, respectively).RNFL and GC-IPL thicknesses were found lower in Parkinson's patients. These parameters may be useful to evaluate neurodegeneration and to monitorize neuroprotective therapies.

Background and Aims Fabry disease is a rare metabolic disorder, lifelong enzyme replacement therapy with recombinant human alpha-galactosidase A (agalsidase) constituted the cornerstone of disease-specific therapy. COVID-19 pandemic and epidemic control measures including lockdowns impaired access to health care services. We examined the effect of COVID-19 pandemic and lockdown measures on mood status and management of Fabry disease patients. Method We conducted a cross-sectional study between October 2020 and December 2020. We used the Hospital Anxiety and Depression Scale (HADS) to evaluate the mood statuses of FD patients and the Morisky Medication Adherence Scale (MMAS-4) to assess patient adherence. We also examined age and sex-matched control group to compare mood status. Results A total of 68 (Male 48.5 %, mean age 37.0) FD patients were under regular follow-up in our institution, 59 of those patients were taking ERT every other week. Two of our patients had reported having a COVID-19 infection, and both of them recovered. 25 patients reported to miss an ERT for a median of one dose, 16 of these 25 patients have reported that they did not come to the hospital because of infection fear. Half of the patients had adopted home-based infusion; they arranged a nurse for home-based infusion therapy by their own means. According to MMAS-4 FD patients had good adherence to their therapy (Median score 0, range 0-2). Mood status of FD patients and controls are shown in Table 1. Both HADS depression and anxiety scores were higher in the control group compared to FD patients. Additionally, abnormal scores were more prevalent for HADS depression scores in controls (Figure 1). Conclusion We found that the mood status of FD patients was better than the control group. Traumatic growth may be an important factor to explain this finding. Their adherence to therapy was good. Home-based therapy was the preferred method by the patients. Government-supported home therapy programs might be beneficial for FD patients to increase adherence to the therapy.

IntroductionVaccination programs aim to control the COVID-19 pandemic. However, the relative impacts of vaccine coverage, effectiveness, and capacity in the context of nonpharmaceutical interventions such as mask use and physical distancing on the spread of SARS-CoV-2 are unclear. Our objective was to examine the impact of vaccination on the control of SARS-CoV-2 using our previously developed agent-based simulation model.MethodsWe applied our agent-based model to replicate COVID-19-related events in 1) Dane County, Wisconsin; 2) Milwaukee metropolitan area, Wisconsin; 3) New York City (NYC). We evaluated the impact of vaccination considering the proportion of the population vaccinated, probability that a vaccinated individual gains immunity, vaccination capacity, and adherence to nonpharmaceutical interventions. The primary outcomes were the number of confirmed COVID-19 cases and the timing of pandemic control, defined as the date after which only a small number of new cases occur. We also estimated the number of cases without vaccination.ResultsThe timing of pandemic control depends highly on vaccination coverage, effectiveness, and adherence to nonpharmaceutical interventions. In Dane County and Milwaukee, if 50% of the population is vaccinated with a daily vaccination capacity of 0.1% of the population, vaccine effectiveness of 90%, and the adherence to nonpharmaceutical interventions is 65%, controlled spread could be achieved by July 2021 and August 2021, respectively versus in March 2022 in both regions without vaccine. If adherence to nonpharmaceutical interventions increases to 70%, controlled spread could be achieved by May 2021 and April 2021 in Dane County and Milwaukee, respectively.DiscussionIn controlling the spread of SARS-CoV-2, the impact of vaccination varies widely depending not only on effectiveness and coverage, but also concurrent adherence to nonpharmaceutical interventions. The effect of SARS-CoV-2 variants was not considered.Primary Funding SourceNational Institute of Allergy and Infectious Diseases